With early detection and proper treatment, skin cancer is a highly treatable disease with an excellent rate of recovery. Even so, a skin cancer diagnosis is a difficult and overwhelming experience with many challenging decisions to be made.
First and foremost, remember that your medical team is there to provide information, support, and guidance. Don’t hesitate to ask for clarification on any aspect of your diagnosis and treatment, and be sure to have in-depth discussions about the various options available to you.
Every case is unique, so your doctor will recommend a treatment option(s) that is tailored according to your type of cancer, the stage you are in, your general health, and other factors.
Cryosurgery
What is cryosurgery?
Using a specialized applicator or spray device, the doctor applies the liquid nitrogen to the growth. The liquid nitrogen freezes the tissue, which will often then fall off on its own. The procedure involves minimal discomfort and typically doesn’t require local anesthesia.
What is cryosurgery used for?
Cryosurgery is frequently used to treat actinic keratoses, which are precancerous skin growths/lesions. It is often the preferred treatment option when only a small number of precancerous growths are present.
Cryosurgery can also be used as a treatment for superficial basal cell carcinomas, and in rare cases, superficial squamous cell carcinomas.
Curettage and Electrodesiccation
What is curettage and electrodesiccation?
After local anesthesia has been applied, the doctor uses a special instrument (called a “curette”) to scrape off some or all of the growth. Then, a technique called electrodesiccation is used to cauterize the area, eliminating any remaining abnormal cells. In some cases, the process may be repeated twice in a single session.
What are curettage and electrodesiccation used for?
This technique may be an option for actinic keratoses (precancerous skin lesions), as well as certain skin cancers, including some superficial basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).
However, this treatment is not usually suggested for larger, invasive, or aggressive BCCs or SCCs. Additionally, lesions on the face are not typically an ideal match for this technique.
Excisional Surgery
What is excisional surgery?
Your doctor will use a scalpel to remove (“excise”) the melanoma tumor, as well as a small “safety margin” of the surrounding healthy tissue. When surgery is complete, the margins will be evaluated to make sure the area is cancer-free. If there is evidence of remaining skin cancer beyond the margin, the doctor may perform another surgery at a later date.
What is excisional surgery used for?
Excisional surgery may be a treatment option for melanomas, basal cell carcinomas, and squamous cell carcinomas. Tumors that are detected at an early stage (before spreading beyond the tumor margin) may not require any additional treatment after excisional surgery.
Immunotherapy
What is immunotherapy?
Immunotherapy is the use of specialized medications to boost the immune system and provide it with the stimulation necessary to destroy cancer cells.
What is immunotherapy used for?
There are several different types of immunotherapy, each one suited to specific patients and cases. It may be used as a secondary treatment for melanomas after excisional surgery has been completed.
Laser Surgery
What is laser surgery?
The doctor uses a specialized beam of light (in a certain wavelength) to target and destroy precancerous cells and some superficial cancers. There are two types of lasers available for this procedure: ablative lasers, which vaporize skin cancer, and non-ablative lasers, which convert the light to heat to destroy the tumor. If your doctor suggests laser surgery, they will discuss specific treatment strategies suited to your case.
What is laser surgery used for?
Laser surgery can be an effective treatment for precancerous actinic keratoses on the face and scalp, as well as precancerous actinic cheilitis on the lips. It may also be an option for superficial basal cell carcinomas, and in a limited number of cases, superficial squamous cell carcinomas.
Some patients may undergo laser surgery as a form of secondary therapy if topical medications and/or other treatments are unsuccessful.
Mohs Surgery
What is Mohs surgery?
This procedure is completed in stages, taking a few days to remove all cancer cells while sparing as much healthy tissue as possible. The doctor carefully removes one layer at a time, examining each with a microscope until the margins can be declared cancer-free. This technique is extremely useful for removing the microscopic “roots” of cancer, which is key for forms of skin cancer with higher risks of spreading.
What is Mohs surgery used for?
This surgical treatment can be an ideal option for treating a wide range of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), particularly in recurring cases of BCCs or SCCs. Recent advancements have also shown Mohs surgery to be an effective treatment for melanomas, including both “in situ” and invasive melanomas.
Photodynamic Therapy
What is photodynamic therapy?
The doctor first applies a topical agent to the targeted treatment areas, causing these regions of skin to become sensitive to light. After allowing the topical to properly absorb into the skin, the doctor uses a strong blue/red light or laser (and, in some cases, natural sunlight) on the medicated areas. Lesions can be destroyed successfully, with minimal damage done to healthy tissue.
What is photodynamic therapy used for?
Photodynamic therapy (PDT) is an FDA-approved treatment for precancerous actinic keratoses (AKs). It is often recommended for widespread AKs on the face and/or scalp. PDT can also be an option for superficial basal cell carcinomas or squamous cell carcinomas.
Radiation
What is radiation?
Radiation therapy utilizes low-energy X-ray beams to target and destroys cancerous growths, particularly those that may be too difficult to manage with surgery (or for patients whose health poses too great a risk for surgical intervention). It can involve several treatments over the course of a few weeks or even daily treatments for a full month.
What is radiation used for?
This treatment may be used for basal cell carcinomas or squamous cell carcinomas, sometimes in combination with other treatments in cases of advanced squamous cell carcinoma. Presently, radiation is being tested in conjunction with complementary treatments for use in cases of advanced melanoma.
How Do I Know Which Treatment is the Best Option for Me?
Before your doctor makes any treatment recommendations, a clear diagnosis will need to be made. Generally, a diagnosis will detail:
- The type of skin cancer
- The location, size, and characteristics of cancerous growth(s)
- The stage of cancer, if applicable
Based on your diagnosis, your doctor will then move forward with suggestions for one or more potential treatment options.
Below, we have provided a brief explanation of each of the main types of skin cancer, their diagnosis process, and possible treatments.
Actinic Keratosis (AK)
An actinic keratosis is a precancerous lesion, specifically an indication of skin damage that increases your skin cancer risk. Treating AKs can be a proactive method for reducing that risk.
Actinic keratosis treatment options
Treatment for actinic keratosis depends on the number and location of lesions, as well as your age and general health. Options may include one or more of the following:
- Cryosurgery
- Curettage and electrodesiccation
- Laser surgery
- Topical treatments (prescription medication creams, gels, and/or solutions)
- Photodynamic therapy
Basal Cell Carcinoma (BCC)
With early detection and treatment, BCCs can be effectively cured. However, as the tumor increases in size, treatment will need to be more extensive. In some cases, rare and aggressive BCCs can be fatal without prompt treatment.
Basal cell carcinoma treatment options
For small or early-stage BCCs, there are many effective treatment options (some of which are performed on an outpatient basis). These include:
- Curettage and electrodesiccation
- Mohs surgery
- Excisional surgery
- Radiation therapy
- Photodynamic therapy
- Cryosurgery
- Laser surgery
- Topical medications
In cases of advanced BCCs, a combination of treatments may be used. For example, radiation is sometimes used following surgery as a treatment for advanced BCC. There are also prescription medications used for advanced BCCs.
Melanoma
Melanoma is one of the most serious forms of skin cancer, caused by UV ray exposure that leads to mutations (damage) in the DNA of your skin cells.
Melanoma diagnosis
Your dermatologist will perform a biopsy on a suspicious lesion, then send it to a lab for testing. If cancer cells are present, the lesion can be diagnosed as melanoma.
The next step will be to determine which stage of melanoma you are in. This process can require additional testing, such as CT scans, PET scans, MRIs, and/or blood tests. Your doctor will also use the TNM system, which is a diagnosis process developed by the American Joint Committee on Cancer (AJCC) to assess:
- The extent of the original tumor (T), how deep/thick it has become, and whether or not it has ulcerated (begun to break down)
- Whether cancer has spread to nearby (N) lymph nodes, or if the tumor is “in transit” and spreading towards the lymph nodes
- The extent of metastasis (M), otherwise known as the spread, to other skin sites, lymph nodes, and/or organs
What are the stages of melanoma?
Early melanomas are localized and have not yet spread to other skin and body areas. The stages of early melanomas include:
- Stage O: The melanoma is localized in your skin’s outermost layer (also called “melanoma in situ”).
- Stage I: Cancer measures less than 1 mm deep and may or may not be ulcerated. It is still localized but is considered invasive, meaning it has penetrated to the layer of skin directly below the top layer. A Stage IA tumor can be classified as thin/early if it is less than 0.8 mm and not ulcerated.
Intermediate or high-risk melanomas are larger, localized tumors with specific traits that make them more likely to spread. The stages of intermediate and high-risk melanomas include:
- Stage II: The tumor is deeper than 1 mm, may or may not be ulcerated, and has a high risk of spreading. Thicker melanomas (more than 4 mm) are characterized as having a very high spread risk, and ulceration increases the severity of the diagnosis.
Advanced melanomas are those that have spread from the primary tumor to other areas of the body. The stages of advanced melanoma include:
- Stage III: The tumor has either spread more than 2 cm beyond the primary tumor and through a lymph vessel (not yet to the local lymph nodes) or all the way to the local lymph nodes. By Stage III, thickness is no longer a key factor.
- Stage IV: Cancer has spread to distant body areas, organs, and/or lymph nodes, most often the lungs, brain, bone, liver, or gastrointestinal tract.
Melanoma treatment options
Depending on your case, your doctor may suggest one of the following melanoma treatments or a combination of two or more:
- Excisional surgery
- Mohs surgery
- Sentinel lymph node biopsy
- Immunotherapy
- Radiation
- Other targeted therapies
Squamous Cell Carcinoma (SCC)
When detected and treated early, SCCs can be treated with a high rate of success. More advanced cases of SCC are often more challenging to treat and can spread to local lymph nodes, distant organs, and tissues.
Squamous cell carcinoma treatment options
An early SCC may be treated with outpatient procedures, with options depending on the type, size, depth, and location of the tumor, as well as your health and age. Treatments for squamous cell carcinoma include:
- Excisional surgery
- Mohs surgery
- Cryosurgery
- Curettage and electrodesiccation (electrosurgery)
- Laser surgery
- Radiation
- Photodynamic therapy (PDT)
- Topical medications
Rare Forms of Skin Cancer
In addition to the types listed above, there are many other skin cancers that are considered significantly rarer:
- Dermatofibrosarcoma protuberans (DFSP)
- Kaposi’s sarcoma
- Microcystic adnexal carcinoma (MAC)
- Merkel cell carcinoma (MCC)
- Sebaceous carcinoma
- Undifferentiated pleomorphic sarcoma
- Extramammary Paget’s disease (EMPD)